OmahaD Registration 2010.tif FOR OFFICE USE ONLY
CITY OF BLAIR 185
218 S. 16TH STREET Date Paid: /
BLAIR, NE 68008 Receipt No: lye-) y.
(402) 426 -4191 Date Issued:
FAX (402) 426 -4195
email: CityofBlair @huntel.net BOND EXPIRES:
0
q Promise o (Continued)
i
CONTRACTOR REGISTRATION /LICENSE RENEWAL
Verify the following information:
Business Name: Omaha Door & Window Co., Inc.
Address
4665 "G" Street
Omaha, NE 68117
Phone # 402 - 733 -6 440
Mobile #
Number of Employees: _ Journeymen: Apprentices:
I
Type of Business: General Contractor
i
Other Licenses Held:
Insured? Yes Worker's Compensation? Yes
Place a check in the box next to the licenses you wish to renew:
Renew? Name License / Registration Certificate of Liability Expires Amount
i
General Contractor 4/1/2010 $60.00
T List additional license / registrations:
Name License / Registration Bond Expires Amount
i
All information contained in this application is true and correct. I will notify the City of Blair of any changes in
the information reported on or with this application form within 15 days of the change.
I hereby make application to the Licensing Board of Blair, Nebraska and certify that I am competent and
experienced to engage in above said vocation. ,)'agree to conform strictly to the Ordinances of the City of
Blair, Nebraska relative to said vocation and obey all order, requirements and regulations of its lawful
constituted authorities.
/ 1 11 4
Authorized Signature Date